Provider Demographics
NPI:1366898025
Name:DRAKE, LEMICHAL (CCRP)
Entity type:Individual
Prefix:MR
First Name:LEMICHAL
Middle Name:
Last Name:DRAKE
Suffix:
Gender:M
Credentials:CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5773 OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3202
Mailing Address - Country:US
Mailing Address - Phone:601-994-4647
Mailing Address - Fax:
Practice Address - Street 1:5773 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3202
Practice Address - Country:US
Practice Address - Phone:601-994-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator